Healthcare Provider Details

I. General information

NPI: 1679410906
Provider Name (Legal Business Name): CREATIVE SOCIAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE PONCE DE LEON PARADA 22 1/2
SAN JUAN PR
00917-1802
US

IV. Provider business mailing address

URB VEREDAS 764 CAMINO DE LOS CEDROS
GURABO PR
00778-9998
US

V. Phone/Fax

Practice location:
  • Phone: 305-588-5990
  • Fax:
Mailing address:
  • Phone: 305-588-5990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY PEGUERO SANCHEZ
Title or Position: OWNER
Credential: PHL
Phone: 305-588-5990